05. safe injection practice.pptx

Safe injection practice, multidose vial policy, safe infusion practice,

1. Safe Injection & Infusion Practice Practices + Open Vial Policy + Needle Stick Injury + Blood Transfusion Infection Control Department Labaid Hospital

2. definition The World Health Organization (WHO) defines a safe injection to be one that does not harm the recipient, does not harm the health care worker, and does not harm the community.

3. Some of the incorrect practices that have resulted in transmission • Using the same syringe to administer medications to more than one patient, even if the needle was changed • Using a common bag of saline or other IV fluid for more than one patient, and – Leaving an IV set in place for dispensing fluid – Accessing the bag with a syringe that has already been used to flush a patient’s IV or catheter • Accessing a shared medication vial with a syringe that has already been used to administer medication to a patient

4. Injection Safety Guidelines From CDC Follow proper infection control practices and maintain aseptic technique during the preparation and administration of injected medications (e.g., perform hand hygiene). Never administer medications from the same syringe to more than one patient, even if the needle is changed. Never enter a vial with a used syringe or needle . Do not use medications packaged as single-dose or single-use for more than one patient. Do not use bags of intravenous solution as a common source of supply for more than one patient. Limit the use of multi-dose vials and dedicate them to a single patient whenever possible. Always use facemasks (with appropriate PPE) when injecting material or inserting a catheter into the epidural or subdural space.

5. Safe Infusion practice Infusion name Time of changing the set IV infusion, No additives (NS, DA, DNS, Koloride , Hartman, baby saline) 72 hours IV infusion with any additives (vitamins, electrolytes, insulin) 24 hours IV infusion with any additives (antibiotic/any medicines other than IV saline) & PMO line of syringe pump/micro burette set 24 hours IV infusion with nutrient rich fluid (Albumin/ prosol / fatisol ) 24 hours Blood transfusion (WB, PCV, Apharesis ) With each bag Blood transfusion (platelet, FFP) Better to change with each bag, but can be changed Every 2-4 hours in case of emergency

6. Open vial policy Date multidose vials when first opened. Discard within 28 days unless the manufacturer specifies a shorter or longer date for that opened vial. Any Multidose vial/bottle have to be discarded after 28 days if not otherwise mentioned by the manufacturer. Medication containers (single and multidose vials, ampoules, and bags) are entered with a new needle and new syringe, even when obtaining additional doses for the same patient. Whenever possible, make multi dose vial for single patient use only. Ensure the prescribed storage condition. Never seal a broken ampoule with micropore for reuse. Do not combine (pool) leftover contents of single-dose vials for later use. Disinfect the rubber septum on a medication vial with alcohol before piercing.

7. Type of Blood Components Packed red blood cells (RBCs) 250-350 ml within 4h Whole Blood 300-550 ml/ hr within 4h Platelets Maximum infusion time is 15-30 minutes. Fresh frozen plasma 200-250ml, Infusion time is1 5- 30 minutes per bag Cryoprecipitates White blood cells (WBCs) All units must be given within 4 hours of defrosting

8. Precautions and Nursing Responsibilities Blood Warmers can be used only when several units (>6 PRBC in a short period of time) of blood administered  Only use devices tested for this purpose  Do not warm blood products in microwave or hot water Blood must be administered as soon as possible after being received from blood bank, within 15 minutes Blood administration sets should be changed every 2-4 hours/ with every blood bag. Blood should not be infused rapidly unless platelets, which may be infused rapidly, with caution. No medications should be added to blood bag or into blood transfusion – Only normal saline should be infused or added to blood components Measure vital signs, lung sounds before and after 15 minutes of transfusion, then every hour until completed T wo RNs should check blood bag for the points shown in the picture.

9. Allergic Fever > 1 ◦ C above the baseline, Flushing, hives/rash , urticaria, itching, pruritus, Headache, anxiety, low BP Intervention : Stop the transfusion  Maintain the IV line with NS  Call the RMO  Administer antihistaminic Fever > 1 ◦ C above the baseline, chills, anxiety Headache, tachycardia, Tachypnoea, muscle pain Intervention : Stop the transfusion  Maintain the IV line with NS  Call the RMO  Administer antipyretics  Monitor temperature every 4 h Febrile (non Hemolytic)

10. Acute Hemolytic Occur within 15 minutes of transfusion  Nauseas, vomiting, lower back pain, hypotension, decreased urinary output, hematuria, increased sensation heat, increased temperature apprehension, bronchospasm, DIC Interventions include : Stop the transfusion  Maintain the IV line with NS  Notifying RMO and blood bank  Sending blood & urine specimen to blood bank  Returning all blood tubing and bags to blood bank  Keep necessary documentation Occurred after 2 -14 days  Monitor for signs of delayed reactions (which may occur up to 1 year following transfusion)  these include fever, mild jaundice, decreased hematocrit level DELAYED Hemolytic

11. Circulatory overload  Monitor for signs; these include cough, dyspnea, chest pain, wheezing, hypertension, tachycardia  Interventions include slowing rate of infusion, placing client upright with feet in dependent position, notifying health care provider, administering oxygen, diuretics, and morphine sulfate as prescribed, monitoring for dysrhythmias Unconscious  Monitor for signs in unconscious client; these include weak pulse, fever, tachycardia or bradycardia, hypotension, visible hemoglobinuria Septicemia  Monitor for signs; these include rapid onset of chills and high fever,  vomiting, diarrhea, hypotension, shock  Interventions include notifying health care provider  obtaining blood cultures and cultures from blood bag  administering oxygen  IV fluids, antibiotics, vasopressors, and corticosteroids as prescribed Iron overload  Assess for altered hematological values  Vomiting and diarrhea  Hypotension  Interventions include administering deferoxamine ( Desferal ) as prescribed to remove iron in the kidney  Educating client that urine will turn red as iron is excreted

12. Complications Disease transmission Hepatitis C is commonly transmitted disease Other transmitted diseases may include hepatitis B, HIV, Epstein-Barr virus, cytomegalovirus, malaria Hypocalcemia Monitor for hyperactive reflexes, paresthesia, cramps, positive Trousseau’s and Chvostek’s signs  Slow transfusion rate, notify health care provider if signs occur Hyperkalemia The older the blood, the greater the risk for hyperkalemia, because hemolysis causes potassium release Monitor for muscle weakness, paresthesias , abdominal cramps, diarrhea, dysrhythmias Slow transfusion rate, notify health care provider if signs occur

13. Occupational exposure Needlestick/sharp Injury Splash injury

14. WHAT INFECTIONS CAN BE CAUSED BY SHARP INJURIES? Sharps injuries can expose workers to a number of blood borne pathogens that can cause serious or fatal infections. The pathogens that pose the most serious health risks are Hepatitis B virus (HBV) Hepatitis C virus (HCV) Human immunodeficiency virus (HIV)

15. RISKS OF SEROCONVERSION DUE TO SHARPS INJURY FROM A KNOWN POSITIVE SOURCE Virus Risk (Range) HBV 9-30% HCV 1-1.8% HIV 0.3% The risk of exposure following mucous membrane exposure is relatively less (0.09% For HIV)

16. Devices associated with needlestick injuries

17. Activity during which needlestick and sharp injuries occur

18. Do’S For sharp injury : Wash the wound & surrounding area with soap & water. For splash injury: Irrigate thoroughly the site vigorously with water for 5 minutes For Eye splash: Sit in a chair, tilt the head back and ask a colleague to gently pour water or normal saline over the eye For mouth splash: spit fluid out immediately, if gone into mouth then rinse the mouth several times using water or saline Do not panic Do not place the pricked finger into the mouth reflexively Do not squeeze blood from wound Do not use antiseptics and detergent No evidence exists that using antiseptics for wound care or expressing fluid by squeezing the wound further reduces the risk of BB pathogen transmission DONT’S First aid management of exposed site